Clinical performance of GAAD score, alpha-fetoprotein, and PIVKA-II in diagnosing hepatocellular carcinoma in the Vietnamese cohort.

Abstract

Objective: Alpha-fetoprotein (AFP), PIVKA-II, and GAAD have been studied effectively for the early diagnosis of hepatocellular carcinoma (HCC), creating an opportunity for effective treatment, thereby improving the survival outcomes. However, evidence was scarce in Vietnam, where patients were largely diagnosed at advanced stages with poor prognosis.

Methods: A retrospective study was conducted at a single-center in Vietnam to investigate clinical application of standard cutoffs GAAD (2.57), AFP (20 ng/mL), and PIVKA-II (28.4 ng/mL). Receiver operating characteristic (ROC) analysis and area under the curve (AUC) values were calculated for all markers.

Results: Among 2611 participants, there were 128 (4.9%) diagnosed with HCC. In HCC cases, 91.41% were aged ≥ 50 with a male to female ratio of 3.9. There were 58.59% with cirrhosis and 63.28% with hepatitis, dominated by hepatitis B (52.34%). GAAD score attained 98.33% of AUC, sensitivity of 86.7%, and specificity of 98.4%. GAAD was more effective than PIVKA-II and AFP in screening HCC patients. A strategy of combining PIVKA-II and AFP overcame limitations of these two biomarkers used alone, denoted by higher values of sensitivity (84.4%) and specificity (96.0%).

Conclusion: This study in Vietnam revealed the performance of GAAD and PIVKA-II plus AFP in the HCC screening strategy. These strategies appeared effective for HCC patients regardless of tumor size (≤ 2 cm) or patient age (≥ 50). Further study is encouraged to confirm these findings.